{"title":"恶性外耳道炎：手术的作用是什么？","authors":"Lisa Zhang, Joseph Bonanno, Woo Yul Byun, Yin Ren","doi":"10.1002/lio2.70029","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Malignant otitis externa (MOE) is typically managed with long-term broad-spectrum antibiotics. The impact of surgical intervention on clinical outcomes is not well described. This study aims to compare clinical outcomes of MOE patients managed with or without surgery.</p><p><strong>Study design/setting: </strong>Retrospective cohort, academic tertiary referral center.</p><p><strong>Methods: </strong>Patients diagnosed with MOE between January 2010 to September 2022 were included. Univariate analyses compared symptoms at initial presentation and long-term (≥1 year) outcomes between surgical and non-surgical patients.</p><p><strong>Results: </strong>A total of 23 patients were included (78% male, mean age 69 ± 13 years, median follow-up 305 days). Most (<i>N</i> = 22, 96%) patients were diabetic. Seventeen (74%) underwent surgical intervention (76% tympanomastoidectomy, 24% external auditory canal debridement and biopsy). Poor facial nerve (FN) function at initial presentation (defined as House-Brackmann [HB] grade ≥3) significantly predicted undergoing surgical intervention (<i>p</i> = 0.02). Comparing surgically managed versus non-surgical patients at the time of presentation, there were no differences in the degree of hearing loss, severity of diabetes, rate of insulin dependence, incidence of immunosuppression, or the Charlson Comorbidity Index (all <i>p</i> > 0.05). FN outcomes at long-term follow-up also did not significantly differ (p > 0.05). No significant differences in the length of stay (9 vs. 6 days, <i>p</i> = 0.2), rate of readmission (31% vs. 17%, <i>p</i> = 0.5) or 5-year overall survival (53% vs. 66%, <i>p</i> = 0.6) were observed between surgical and non-surgical patients.</p><p><strong>Conclusions: </strong>Long-term outcomes for patients with MOE remain poor. Patients with poor FN function at presentation were more likely to undergo surgical intervention. Patient comorbidities, including the severity of diabetes, were not predictive of undergoing surgery. However, surgical intervention for MOE did not appear to lower the length of stay, the rate of hospital readmission, or overall mortality in our cohort.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"9 6","pages":"e70029"},"PeriodicalIF":1.6000,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11645471/pdf/","citationCount":"0","resultStr":"{\"title\":\"Malignant otitis externa: What is the role of surgery?\",\"authors\":\"Lisa Zhang, Joseph Bonanno, Woo Yul Byun, Yin Ren\",\"doi\":\"10.1002/lio2.70029\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Malignant otitis externa (MOE) is typically managed with long-term broad-spectrum antibiotics. The impact of surgical intervention on clinical outcomes is not well described. This study aims to compare clinical outcomes of MOE patients managed with or without surgery.</p><p><strong>Study design/setting: </strong>Retrospective cohort, academic tertiary referral center.</p><p><strong>Methods: </strong>Patients diagnosed with MOE between January 2010 to September 2022 were included. Univariate analyses compared symptoms at initial presentation and long-term (≥1 year) outcomes between surgical and non-surgical patients.</p><p><strong>Results: </strong>A total of 23 patients were included (78% male, mean age 69 ± 13 years, median follow-up 305 days). Most (<i>N</i> = 22, 96%) patients were diabetic. Seventeen (74%) underwent surgical intervention (76% tympanomastoidectomy, 24% external auditory canal debridement and biopsy). Poor facial nerve (FN) function at initial presentation (defined as House-Brackmann [HB] grade ≥3) significantly predicted undergoing surgical intervention (<i>p</i> = 0.02). Comparing surgically managed versus non-surgical patients at the time of presentation, there were no differences in the degree of hearing loss, severity of diabetes, rate of insulin dependence, incidence of immunosuppression, or the Charlson Comorbidity Index (all <i>p</i> > 0.05). FN outcomes at long-term follow-up also did not significantly differ (p > 0.05). No significant differences in the length of stay (9 vs. 6 days, <i>p</i> = 0.2), rate of readmission (31% vs. 17%, <i>p</i> = 0.5) or 5-year overall survival (53% vs. 66%, <i>p</i> = 0.6) were observed between surgical and non-surgical patients.</p><p><strong>Conclusions: </strong>Long-term outcomes for patients with MOE remain poor. Patients with poor FN function at presentation were more likely to undergo surgical intervention. Patient comorbidities, including the severity of diabetes, were not predictive of undergoing surgery. However, surgical intervention for MOE did not appear to lower the length of stay, the rate of hospital readmission, or overall mortality in our cohort.</p><p><strong>Level of evidence: </strong>III.</p>\",\"PeriodicalId\":48529,\"journal\":{\"name\":\"Laryngoscope Investigative Otolaryngology\",\"volume\":\"9 6\",\"pages\":\"e70029\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-12-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11645471/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Laryngoscope Investigative Otolaryngology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/lio2.70029\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"OTORHINOLARYNGOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Laryngoscope Investigative Otolaryngology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/lio2.70029","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：恶性中耳炎（MOE）通常采用长期广谱抗生素治疗。手术治疗对临床疗效的影响尚未得到很好的描述。本研究旨在比较接受或不接受手术治疗的 MOE 患者的临床疗效：研究设计/设置：回顾性队列，学术性三级转诊中心：方法：纳入2010年1月至2022年9月期间诊断为MOE的患者。单变量分析比较了手术和非手术患者初次发病时的症状和长期（≥1年）疗效：共纳入 23 名患者（78% 为男性，平均年龄为 69 ± 13 岁，中位随访时间为 305 天）。大多数患者（22 人，96%）患有糖尿病。17名患者（74%）接受了手术治疗（76%为鼓室切除术，24%为外耳道清创和活检术）。初次发病时面神经（FN）功能不佳（定义为 House-Brackmann [HB] 等级≥3）明显预示要接受手术治疗（p = 0.02）。将发病时接受手术治疗的患者与未接受手术治疗的患者进行比较，两者在听力损失程度、糖尿病严重程度、胰岛素依赖率、免疫抑制发生率或 Charlson 合并症指数方面均无差异（均 p > 0.05）。长期随访的 FN 结果也无显著差异（P > 0.05）。手术和非手术患者的住院时间（9天 vs. 6天，p = 0.2）、再入院率（31% vs. 17%，p = 0.5）或5年总生存率（53% vs. 66%，p = 0.6）均无明显差异：结论：MOE 患者的长期预后仍然不佳。结论：MOE患者的长期预后仍然不佳，发病时FN功能较差的患者更有可能接受手术治疗。患者的合并症，包括糖尿病的严重程度，并不能预测是否接受手术治疗。然而，在我们的队列中，手术干预治疗MOE似乎并不能缩短住院时间、降低再入院率或总死亡率：证据等级：III。
Malignant otitis externa: What is the role of surgery?
Objective: Malignant otitis externa (MOE) is typically managed with long-term broad-spectrum antibiotics. The impact of surgical intervention on clinical outcomes is not well described. This study aims to compare clinical outcomes of MOE patients managed with or without surgery.
Study design/setting: Retrospective cohort, academic tertiary referral center.
Methods: Patients diagnosed with MOE between January 2010 to September 2022 were included. Univariate analyses compared symptoms at initial presentation and long-term (≥1 year) outcomes between surgical and non-surgical patients.
Results: A total of 23 patients were included (78% male, mean age 69 ± 13 years, median follow-up 305 days). Most (N = 22, 96%) patients were diabetic. Seventeen (74%) underwent surgical intervention (76% tympanomastoidectomy, 24% external auditory canal debridement and biopsy). Poor facial nerve (FN) function at initial presentation (defined as House-Brackmann [HB] grade ≥3) significantly predicted undergoing surgical intervention (p = 0.02). Comparing surgically managed versus non-surgical patients at the time of presentation, there were no differences in the degree of hearing loss, severity of diabetes, rate of insulin dependence, incidence of immunosuppression, or the Charlson Comorbidity Index (all p > 0.05). FN outcomes at long-term follow-up also did not significantly differ (p > 0.05). No significant differences in the length of stay (9 vs. 6 days, p = 0.2), rate of readmission (31% vs. 17%, p = 0.5) or 5-year overall survival (53% vs. 66%, p = 0.6) were observed between surgical and non-surgical patients.
Conclusions: Long-term outcomes for patients with MOE remain poor. Patients with poor FN function at presentation were more likely to undergo surgical intervention. Patient comorbidities, including the severity of diabetes, were not predictive of undergoing surgery. However, surgical intervention for MOE did not appear to lower the length of stay, the rate of hospital readmission, or overall mortality in our cohort.
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